Psychiatry EOR Flashcards
What are the symptoms of serotonin syndrome?
Mental status changes Autonomic instability (Tachy, diarrhea, diaphoresis, mydriasis) Neuromuscular abnormalities (Clonus, hyperreflexia, tremor, seizures)
Is serotonin syndrome fast or slow onset?
Fast onset
What criteria is used to diagnosis serotonin syndrome?
Hunter criteria
What is the treatment for serotonin syndrome?
Benzodiazepines
Hydration/Cooling
Cyproheptadine
What syndrome presents very similar to serotonin syndrome, but is caused by exposure to halogenated anesthetics(halothane) or depolarizing muscle relaxants (Succinylcholine, suxamethonium)?
Malignant hyperthermia
What is the pharmacologic treatment for malignant hyperthermia?
Dantrolene
What syndrome presents similarly to serotonin syndrome, but develops slowly, and is associated with slowed neuromuscular activity rather than hyperactivity.
Neuroleptic malignant syndrome.
What medications can cause neuroleptic malignant syndrome?
Neuroleptic agents (antipsychotics - such as haloperidol, fluphenazine, clozapine) Antiemetics (metoclopramide, promethazine) Withdraw from dopamine agonist therapy
Where are neuromuscular symptoms most profound in a patient with serotonin syndrome?
In the lower extremities.
Is autism spectrum disorder more common in males or females?
Males
What 2 criteria must be met to diagnose autism spectrum disorder? (From the DSM-5)
- Persistent deficits in social communication and interaction
- Restricted, repetitive patterns of behavior, interests, or activities.
Patients who are diagnosed with conduct disorder have a high likelihood of developing which personality disorder?
Antisocial personality disorder.
What is the mechanism of actions for benzodiazepines?
Potentiation of endogenous gamma-aminobutyric acid type A. (GABA)
What are the signs and symptoms of benzo withdrawal?
Anxiety, insomnia, tremor, diaphoresis, nausea, vomiting, palpitations, headache, and poor concentration.
Is benzo withdrawal fatal?
Yes
What is the mechanism of action of ampheteamines?
Increased release of catecholamines through inhibition of monoamine oxidase.
Inhibition of dopamine receptors is the mechanism of action of what type of medications?
Antipsychotics
What can be used for sleep in a patient who has insomnia and is being tapered off benzodiazepines?
Melatonin.
What illicit drug is known commonly as angel dust?
Phencyclidine (PCP)
What are some common physical exam findings in a patient who ingested PCP?
HTN, tachycardia, nystagmus (horizontal, vertical, or rotatory), and behavior changes.
Argyll Roberston pupil most commonly occurs with what condition?
Neurosyphilis
What is an argyll robertson pupil?
A pupil that accommodates when the patient is asked to focus on near and distant objects alternatively, but does not react to light exposure.
Which modern anesthetic is derived from phencyclidine?
Ketamine.
What are the core characteristics of schizotypal personality disorder?
Cognitive and perceptual disturbances (magical thinking, paranoia, suspiciousness, and ideas of reference), interpersonal difficulties, oddities of behavior or appearance, and disorganized thought or speech.
What is the pharmacologic treatment for schizotypal personality disorder?
Guanfacine (alpha 2A adrenergic agonist) can help with cognitive organization and anxiety.
Stimulant medications may also be prescribed, but they may increase anxiety.
What are ideas of reference?
The belief that irrelevant and innocuous things in the world have great personal significance.
What is agoraphobia?
Fear of panic symptoms
True or false: most phobias improve spontaneously over time without treatment.
False, phobias tend to be lifelong in the absence of treatment.
What are the 5 types of specific phobias? Name an example of each.
Animal - fear of spiders Natural environment - fear of storms Blood-Injection-Injury - fear of medical procedures with needles Situational - fear of flying Other - fear of costumed characters
Unstable interpersonal relationships, unstable self image, recurrent suicidal behavior, feelings of emptiness, difficulty controlling anger, and paranoid ideation are all symptoms of ______.
Borderline personality disorder
Which of the borderline personality disorder’s diagnostic criteria is most commonly found in individuals with the disorder?
Affective instability.
What is the diagnostic criteria for Bipolar II disorder?
At least one hypomanic episode and at least one episode of major depression.
What is a hypomanic episode?
Just a less severe manic episode.
What is the difference between Bipolar I and Bipolar II disorder?
Bipolar I has full on manic episodes, bipolar II does not.
What are the first line treatment options for hypomanic episodes?
Olanzapine and risperidone (second gen antipsychotics)
What are the first line treatments for patients with bipolar disorder who present with a depressive episode?
Quetiapine and lurasidone
Which medication for treating bipolar disorder is associated with an increased risk of Ebstein anomaly following in utero exposure?
Lithium
What is an Ebstein anomaly?
A congenital heart defect in which the tricuspid valve is in the wrong position and blood leaks backwards causing the heart to work less efficiently and causing enlargement of the heart.
What are the symptoms of opioid intoxication?
Decreased mental status and decreased respiratory drive.
Does opioid intoxication cause miosis or mydriasis?
Miosis
What is the treatment for opioid intoxication?
Naloxone, ventilation and supplemental oxygen if necessary.
What medication is the antidote for benzodiazepine intoxication?
Flumazenil
Why should you be cautious of using flumazenil?
You can put the patient into benzo withdrawal and refractory seizures, which can be deadly.
Why is hemodialysis not an effective treatment for opioid intoxication?
The volume of distribution of opioids is too wide.
How long after abrupt cessation of short acting opioids (such as heroin) do withdrawal symptoms begin?
12-24 hours
When do opioid withdrawal symptoms peak?
3 days
When do opioid withdrawal symptoms taper off?
7 days
Is opioid withdrawal lethal?
No
What is the role of clonidine in acute opioid withdrawal?
lonidine is an alpha-2 adrenergic agonist that counters the noradrenergic hyperactivity found in opioid withdrawal.
What are the cluster A personality disorders?
Schizotypal
Paranoid
Schizoid
What are the cluster B personality disorders?
Borderline
Antisocial
Histrionic
Narcissistic
What are the cluster C personality disorders?
Dependent
Avoidant
Obsessive-compulsive
Which nonintravenous benzodiazepine and route of administration combination provides the fastest onset of anxiolytic effects?
Intranasal midazolam.
What are positive symptoms of schizophrenia?
Hallucinations, delusions, disorganized behavior or thoughts.
What are negative symptoms of schizophrenia?
Decreased expression, apathy, avolition, and flat affect.
What is associated with a poorer prognosis is schizophrenia, positive for negative symptoms?
Negative symptoms - usually treatment resistant
What medications are first generation antipsychotics?
Chlorpromazine and haloperidol
What medications are second generation antipsychotics?
Aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone.
What are side effects of first generation antipsychotics?
Neuroleptic malignant syndrome
Extrapyramidal symptoms such as TD, akathisia, and dystonia.
What are side effects of second generation antipsychotics?
Agranulocytosis, metabolic effects (weight gain, insulin resistance, hyperglycemia.)
Which antipsychotic drug has a black box warning of neutropenia?
Clozapine.
A 10-year-old boy presents to the clinic with his mother, who is concerned about his poor school performance. She reports he makes careless mistakes, has difficulty maintaining attention, and is easily distracted during class. Which of the following medications for treating the suspected condition has a black box warning for misuse and dependence?
Methylphenidate
What are the labeled indications, other than attention-deficit/hyperactivity disorder, for clonidine?
Hypertension and vasomotor symptoms associated with menopause.
What is the treatment for pedophilic disorder?
Hormonal therapy, such as leuprolide acetate.
Pedophilic disorder is a specific type of what broader category of disorders?
Paraphilic disorders
How long must sexual urges be present to be diagnosed with paraphilic disorder?
6 months
Which paraphilic disorder refers to an individual receiving intense sexual arousal from rubbing against a nonconsenting individual?
Frotteuristic disorder.
What medication is contraindicated in treatment of MDD or GAD in a patient with anorexia nervosa? Why?
Bupropion - it increases incidence of seizure in patients with an eating disorder.
What is refeeding syndrome?
Marked electrolyte and fluid shifts that may occur while initiating refeeding in patients with anorexia nervosa, leading to rhabdomyolysis, congestive heart failure, and seizures.
What are risk factors for developing schizophrenia?
Birth during late spring or winter, living further from the equator, childhood trauma or CNS infections, cannabis use during adolescence.
Which type of hallucination is most common in schizophrenia?
Auditory.
If not properly managed, conduct disorder may transition into what disorder in adulthood?
Antisocial personality disorder.
What is the first line treatment for oppositional defiant disorder?
Parent training combined with outpatient psychological treatment
What would be the most appropriate treatment for bipolar disorder in an obese female with liver disease?
Lithium, because antipsychotics have metabolic side effects such as increased blood glucose and cholesterol
What labs should be conducted regularly in a patient taking lithium?
Serum lithium levels, thyroid function, electrolytes, kidney function, and EKGs.
Which pharmacologic agents used in the treatment of bipolar I disorder cause weight gain?
The antipsychotics, especially olanzapine, risperidone, and haloperidol.
What is malingering?
An individual creating false medical or psychiatric symptoms for external reward or gain.
What personality disorder can involve self-harm for attention-seeking without deception?
Borderline personality disorder.
How often should an adult patient be screened for unhealthy alcohol use in primary care?
Once every 12 months
What are the three clinical findings that comprise the triad associated with Wernicke encephalopathy?
Encephalopathy, oculomotor dysfunction, and gait ataxia.
What differentiates mild, moderate, and severe oppositional defiant disorder?
The number of settings where the oppositional behavior takes place (one, two, or three settings, respectively).
What are the adverse effects of stimulant medications?
Decreased appetite, poor growth or weight loss, insomnia, social withdrawal, headache, increased heart rate, increased blood pressure, and exacerbation of tics disorders.
What are the three core findings associated with ADHD?
Hyperactivity, impulsivity, and inattention
What are the 3 classic findings in conduct disorder?
Aggression, lying, and stealing.
What are the 3 classic findings in ODD?
Defiant behavior, hostility, and inattention.
What abnormal CBC finding is often seen in patients with anorexia nervosa?
Leukopenia
What electrolyte abnormality is often seen in patients with anorexia nervosa?
Hypokalemia
What is the term to describe fine, downy, dark hair sometimes seen in anorexia nervosa?
Lanugo.
What are the three core features of anorexia nervosa?
Restriction of energy intake relative to requirements leads to significantly low body weight.
Intense fear of gaining weight or persistent behavior interfering with weight gain.
Disturbance in body image.
What are the two types of anorexia nervosa?
Restricting
Binge-eating and purging type
Intoxication with what drug can cause hallucinations, psychosis, catatonia, hyperreflexia, tachycardia, hypoglycemia, and lactic acidosis?
PCP
What is the first line treatment for illness anxiety disorder?
CBT
What is the pharmacologic treatment of choice for illness anxiety disorder?
An SSRI
A 7-year-old boy presents to the clinic with his mother who is concerned because he has been craving ice for the past 2 months. She reports that he consumes about 10 cups of ice per day. Which nutritional deficiency is the history most concerning for?
Iron
What acid base abnormality can be expected in a patient with bulimia nervoas?
Metabolic alkalosis
What chronic problem may be noted in patients with bulimia nervosa who use ipecac syrup to purge?
pecac-induced myopathy, including cardiomyopathy that may be irreversible.
What electrolyte abnormalities may be noted in bulimia nervoas?
Hyponatremia, hypophosphatemia, hypomagnesemia.
True or false: women who begin antidepressants for postpartum depression should continue treatment for 6 to 9 months after symptom resolution.
True.
How long after delivery do symptoms of postpartum blues usually start?
2-3 days
How long after delivery do symptoms of postpartum depression usually start?
Within the first few months postpartum
How soon should symptoms of postpartum blues resolve?
within 2 weeks.
What is the second line treatment for ADHD?
Atomoxetine
Prenatal exposure to what agent is consistently associated with the development of attention-deficit/hyperactivity disorder?
Tobacco.
What is the daily caloric requirement for a healthy woman of normal weight?
30 kcal/kg/day. Patients who have recently normalized their weight generally require 45 to 50 kcal/kg/day to maintain a normal weight.
How long must anxiety symptoms be present for GAD to be diagnosed?
6 months
What effect can SSRIs have on a patients EKG?
They can cause QT prolongation
True or false: selective serotonin reuptake inhibitors reduce the risk of suicide in depressed patients.
False, there is no clear evidence of an increased or decreased risk.
What second generation antipsychotic is most likely to cause hyperprolactinemia?
Risperidone
What are the symptoms of hyperprolactinema?
Hypogonadism, oligomenorrhea, amenorrhea, galactorrhea, and decreased bone mineral density.
What is an alternative treatment for schizophrenia if a patient experiences hyperprolactinemia on an antipsychotic?
Aripiprazole
What is the treatment of choice for treatment resistant schizophrenia?
Clozapine
What lab needs to be checked each time before clozapine is refilled?
CBC - check for agranulocytosis
True or false: antipsychotic medications are most beneficial for treating the negative symptoms of schizophrenia.
False. Negative symptoms are difficult to treat and most pharmacotherapeutic agents lack efficacy in treating these symptoms.
What is the mechanism of action for stimulants in the treatment of ADHD?
Blocking reuptake of Dopamine and norepinephrine
Name 4 stimulants used for ADHD.
Methylphenidate
Dexmethylphenidate
Dextroamphetamine
Dextroamphetamine-amphetamine
What non-stimulant medications can be used for ADHD?
Atomoxetine
Guanfacine
Clonidine
What is the MOA of atomoxetine?
SNRI
What is the MOA of guanfacine and clonidine?
Alpha-2 adrenergic agonists
What is the black box warning for methylphenidate?
High potential for abuse and dependence
What rare but potentially fatal syndrome may occur during treatment for anorexia nervosa?
Refeeding syndrome.
What is the gold standard instrument used for panic disorder?
The Panic Disorder Severity Scale (PDSS).
What fear-related beliefs are associated with agoraphobia in patients without panic disorder?
Fear of illness, fear of being trapped due to a physical limitation, and bodily preoccupation.
Narcissistic personality disorder is in what cluster of personality disorders?
Cluster B
In addition to narcissistic personality disorder, which other personality disorder is marked by a lack of empathy for others?
Antisocial personality disorder.
What anxiety-related psychological disorder is closely associated with panic disorder?
Agoraphobia.
What is the non-pharmacologic treatment for agoraphobia?
CBT
A 16-year-old boy presents with his mother due to behavioral concerns. She is concerned he has antisocial personality disorder. What is the minimum age requirement for diagnosis of antisocial personality disorder?
18
Which personality disorders are part of the cluster A characteristics, where individuals may often appear eccentric or odd?
Paranoid, schizoid, and schizotypal.
All of the following are predisposing factors for PTSD except: ACEs Low socioeconomic status Female sex Being married Psychiatric disease
Being married - there is higher incidence of PTSD in patients who are divorced, separated, or widowed.
Which antihypertensive medications are sometimes used in the treatment of post-traumatic stress disorder?
Alpha-blockers and clonidine.